Download GU System - Handout Female Reproduction

GU System - Handout Female Reproduction
Text: Brunner & Suddarth’s Medical Surgical Nursing: Ch. 46-48
Behavioral Objectives: By the end of this lecture the student will be able to:
 Review the anatomy and physiology of the female genito-urinary systems
 Describe the physical assessment of the female GU systems
 Discuss the application of the nursing process as it relates to patients with
disorders of the female GU system
 Describe etiology, pathophysiology, clinical manifestations, nursing management
and patient education for the following female GU disorders:
o Vaginitis
o Pelvic inflammatory disease (PID)
o Endometriosis
 Discuss incidence, prevention and treatment of the patient with cancer of the GU
system
 Discuss the nursing interventions in pre and post-operative care of patients
undergoing the following surgeries
o Hysterectomy
o Mastectomy
I.
Review the anatomy and physiology of the genito-urinary systems
a. Brunner and Suddarth’s Medical Surgical Nursing pg 1614
b. Breast
i. Female breast development _________ - _______ years
ii. Tail of ____________________
iii. _______________________ ligament
iv. 12-20 _______________
v. Nipple
vi. Areola
c. External Genitalia
d. Internal Reproductive Structures
i. Vagina
1. ___________ membrane
2. Posterior to _______________ & _______________
3. Anterior to ________________
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4. Anterior & Posterior walls _____________
5. Upper vagina surrounds _______________
a. “Inferior ______________________”
ii. Uterus
1. ____________ shaped: _____________________
2. Size _____________ variable: _________________
3. Location: posterior to the ___________________
4. Ligaments: ____________________________________
5. Cervix: _________________ into the vagina
6. Fundus: _______________ of the uterus
7. Endometrium: __________________ of the uterus
iii. Ovaries
1. Connected to the uterus by _______________ ________
2. Contains: _____________________________________
3. Ova / ovum: __________________________________
e. Ovulation Process (pg 1615)
i. Definition: __________ of a __________ ovum from the _______
ii. Follicular Stage
1. ovum ____________ _________(graafian follicle)
2. reaches ____ ________ (of the ovary)
3. ovum _______________
iii. Ovulation
iv. After ovulation
1. Ovum ______________________  _____________
a. If meets a spermatozoon
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i. _______________& ________________
2. Ovum cyst  Corpus Luteum  stays in the __________
a. Produces ________________
b. Prepares the ____________ for the _______ ovum
f. The Menstrual Cycle (pg 1615-1616)
i. Two system control menstruation: ______________ & _________
ii. Hormones
1. Ovaries
a. _____________ & _________________
2. Pituitary
a. ______________  Stim. _________ to _______
b. __________  Stim. ___________ __________
iii. Cyclical Pattern (see table 46-1 pg. 1617)
1. Changes in ______________ & __________________
2. __________ day cycle
Menstrual
Follicular Phase
Ovulation
Luteal Phase
Premenstrual
Phase
Phase
Estrogen
Estrogen
Estrogen
Estrogen
Estrogen
Progesterone
Progesterone
Progesterone
Progesterone
Progesterone
FSH
FSH
FSH
FSH
FSH
LH
LH
LH
LH
LH
Endometrium
Endometrium
Endometrium
Endometrium
Ovaries
Endometrium
Day
g. Menopausal Period: (Pg. 1616)
i. End of reproductive __________
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ii. Age _________ - __________yrs
iii. Menstruation ________________: No menses _______________
iv. _________ not active  ____________ estrogen
1.
Reproductive organs ___________________________
2. ___________ ova mature
II.
Describe the physical assessment of the GU system: pg 1616
a. Health history and clinical manifestations
i. Menstrual history
1. Menarche: ______________ of menstration
ii. Hx of pregnancies
iii. Hx of medications
1. _____________ therapy
2. Hormonal _______________________
3. ___________________ treatment
iv. Pain
1. Dysmenorrhea: Painful _____________________
2. Dyspareunia: Painful _____________________
v. Hx of vaginal discharge
vi. Hx of urinary problems
vii. History of B&B control
viii. Sexual history
ix. Hx of abuse
x. Hx of surgery
xi. Hx of chronic illness or disability
xii. Hx of genetic disorders
b. Physical Assessment (Pg. 1623-1626)
i. Breast: Frequency of self exam: ___________________
1. Assessment question
a. Palpable ____________
b. ________________ changes
c. Pain, swelling, redness
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d. ____________________ changes
2. Findings
a. Erythema
i. Benign local _________________________ or
ii. Superficial _______________
b. Prominent venous pattern
i. _____ blood supply required by _______________
c. Edema & ____________
i. Neoplasm blocking the ______________ drainage
tubes
d. __________-peel appearance / Peau D’Oragne
(__________)
i. Advanced breast ___________________
e. _________________ inversion
f. Sign of dimpling, creasing, changes in contour
g. Palpation – Breast Cancer
i. ______________ mass
ii. ______________ breast
iii. _______________, hard, embedded in tissue
iv. ______-_________________
ii. Mammography
1. Duration: ___________________________
2. Recommended frequency
a. ___________________
b. > ______________ years
iii. Pelvic
1. Frequency: ___________
2. Initial: Age ___________ or ____________ ____________
iv. Positioning: ___________________________________________
v. Inspection
1. Inspects ____________ genitilia
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2. __________ examination
a. ___________ canal
b. ___________
vi. Pap smear (pg 1627)
1.
_____________ sample of the ________________
2.
Purpose: Dx. ___________________________
3. Do not ___________________ before Dr. visit
vii. Bimanual palpation (pg. 1626)
1. ___________ palpation
2. ____________ palpation
viii. Colposcopy (pg. 1628)
1. Portable _________________________
2. Obtain _________________
III.
Describe etiology, pathophysiology, clinical manifestations, nursing management and
patient education for – Vaginitis: (pg 1661 -6)
a. Pathophysiology of Vaginitis
i. Vaginitis : inflammation of the ___________
ii. Normal pH _________ - __________
iii. Lactobacillus acidophilus,
1. ___________the growth of anaerobes
2. produces ___________ ________  ______ pH
3. Produces: hydrogen ____________
iv.  risk if
a. _______________ c. Altered ____________
b. _______________ d. ________________
v. Candida,Trichomonas or other ________________invade the vagina.
b. Clinical manifestations: General
1. Vaginal discharge +…
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a. Itching
e. Edema
b. Odor
f. Aggravated by ________
c. Redness
g. Urethritis
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d. Burning
c. Candida / Vulvovaginal Candidiasis (pg. 1662)
i. Fungal or ____________ infection
ii. Asymptomatic  symptomatic (risk factors)
1. Use of _____________ bacteria   protective organisms
2. ________________
3. Diabetes ______________
4. Human immunodeficiency virus (HIV)
5. ________________ treatment
6. Oral _________________________ therapy
iii. Clinical manifestations
1. Vaginal discharge
a. Color: __________, cottage cheese like
b. The pH of the discharge is ____________
c. ________________
iv. Medical Management
1. _______ ___________ agents
a. Miconazole (Monistat); Nystatin (Mycostatin)
b. Available without prescription
d. Bacterial Vaginosis
i. Overgrowth of ______________________bacteria ______________found
in the vagina and _____________________of lactobacilli
ii. Characterized by:
1. ________________-like odor
2. ________________ vaginal pH
3. ________________ discharge
a. Color: _______________________
4. _____________ discomfort
iii. Medical Management
1. Metronidazole (Flagyl)
2. Clindamycin (Cleocin)
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e. Trichomonas AKA “Trich” (pg 1664)
i. _______ ___________ ______________
ii. ________________ carrier
iii. Clinical manifestations
1. Vaginal discharge
a. ___________________ c. ___________________
b. ___________________ d. ___________________
2. Cervical ________________
3. Multiple small _________________
4. pH ________________________
iv. Complications
1. ___________ life threatening
v. Medical Management
1. Metronidazole (Flagyl)
a. Anti______________ agent
b. Anti _____________ agent
2. ______________ partners
f. Nursing process of Patients with Vulvovaginal infection
i. Assessment
1. Examine: Do not __________________
2. Observe the area for:
a. ___________________ c. ___________________
b. ___________________ d. ___________________
3. Describe symptoms
a. __odor_____________ c. ______burn_________
b. __itch_____________ d. _____dysuria_______
4. Prep a ________________ _____________
5. Test _____________ of discharge
6. Factors that might contribute
a. Physical /chemical factors
i. Constant ___________; tight / synthetic ________
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ii. Perfumes & __________
iii. ______________ / ______________ baths
iv. Poor _____________
v. ______________ hygiene products
b. Psychogenic factors
i. ___________ ________________ ____________
c. Medical conditions
i. __________________
ii. ________________
iii. _____________ partners
ii. Diagnosis
1. ______________related to burning, odor or itching from the
infectious process
2. _____________ related to stressful symptoms
3. Risk for _____________ or spread of infection
4. Deficient _____________about proper hygiene and preventive
measures
iii. Planning and Goals
iv. Nursing Interventions
1. Admin. ______________
2. ____________ baths
3. ____________powder
4. ______________ patient
5. ______________discouraged
6. __________ fitting underwear = good
7. ____________, _____________, non-________________,
heat-_______________ underwear = bad
v. Evaluations/Expected patient outcomes
IV.
Describe etiology, pathophysiology, clinical manifestations, nursing management &
patient ed. for – Pelvic Inflammatory disease (pg. 1670-71)
a. Pelvic Inflammatory Disease – Pathophysiology
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i. AKA: Pelvic _______________________
ii. PID is an inflammatory condition of the pelvic cavity that begins with
cervicitis and may involve the _____________, ________________,
____________ pelvic peritoneum or pelvic vascular system
iii. Infection is usually caused by _____________
1. __________________ and ______________
iv. PID is the most common STD but ______________________
v. Enters through ______________  ___________ canal &
_______________ _____________ ______________ tubes & ovaries
 _____________
b. Risk factors
i. Early age ____________
ii. ________ # sexual partners
iii. Sex with a partner with an ___________
iv. _____________ of STD’s
v. Previous _____________ infection
vi. ____________________ procedures
c. Clinical manifestation
i. Vaginal discharge
ii. ____________
iii. _________________ _____________pain
iv. ______________after menses.
v. Pain  while ___________
vi. Other S&S:
1. Fever
3. N/V
2. Gen. malaise
4. H/A
d. Complications
i. Peritonitis
ii. ______________
iii. _______________ / adhesions
1. Chronic pelvic ____________
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iv. Fallopian tube obstruction 
1. _____________ pregnancy
2. Occlude tubes _______________
v. Bacteremia  ___________________________
vi. Thrombophlebitis  ________________________
e. Medical management
i. ______________ _____________ Antibiotics
ii. Treat ____________________
iii. Treatment at home: ______________________________
iv. Intensive Therapy / Hospital: ___________; ____________; __________
f. Nursing process of Patients with PID
i. Activity: ________________________
ii. Position : _____________________
iii. Vital signs
iv. Assess: ____________________________
v. Administer: ____________________________________
vi. Pain Relief: ____________________________________
V.
Describe etiology, pathophysiology, clinical manifestations, nursing management and
patient education for – Endometriosis (pg. 1680)
a. Endometriosis – etiology
i.
“A benign lesion or lesions with cells similar to those lining the uterus
grow aberrantly in the pelvic cavity outside the uterus.”
ii. __________ pelvic pain & ________________
b. Pathophysiology
i. Misplaced endometrial tissue responds to ____________________
ii. During____________________, the extopic tissue bleeds, mostly into
areas having no __________  ____________ and _______________
iii. Causes_____________ , _____________ and/or __________________
c. Clinical manifestations
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i. Dysmenorrhea
iii. Pelvic pain
ii. Dyspareunia
iv. Depression
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v. Loss of work
vii. Infertility
vi. Relationship
d. Assessment and diagnostic findings
i. _________________
ii. _________________ exam
iii. __________________ exam (pg 1630)
e. Medical managements
i. ___________________________
ii. ___________________________
1. Side effects: _______ retention, weight _________, ____________
iii. Surgery
iv. Pregnancy
f. Nursing process of Patients with Endometriosis
VI.
i. Assessment
1. Hx & PE focus on specific symptoms, effects of meds,
reproductive plans
ii. Diagnosis Planning and Goals
1. Relief of pain, Dysmenorrhea, dyspareunia
2. Avoidance of infertility
iii. Nursing Interventions
1. Dispel myths and encourage the patient to seek care if
Dysmenorrhea or dyspareunia occurs
iv. Evaluations/Expected patient outcomes
Discuss incidence, prevention and treatment of the patient with cancer of the female
GU system:
a. Cancer of the Cervix (pg 1682-85)
i. Pathophysiology
1. Predominantly ___________________ cell cancer
2. Age _____________ - _____________
3. Risk factors
a. ___________ sex partners
b. _________ age at first coitus
c. Sex with men whose partner have had ________________
d. _______ __________ ____________virus
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i. ____________
ii. Causes _________ growths
e. _______________
ii. Clinical Manifestations
1. Early  ___________________
2. Late symptoms
a. Discharge: __________, _________, _________, ______
b. Irregular _____________
c. Leg __________
d. Dysuria
e. ____________ bleeding
f. ____________of extremities
iii. Assessment and diagnostic findings
1. ________________ smear
2. __________________
3. Colposcopy
a. ___________________
iv. Medical management
1. CRYOTHERAPY
2. Surgery: ____________________________
3. Radiation
b. Cancer of the uterus (pg 1685)
i. Pathophysiology
ii. Risk factors
1. Age: ________________
2. Postmenopausal ____________
3. ____________
4. Unopposed _____________
5.
Nulliparity /Infertility
iii. Assessment
1. Irregular _____________ should be evaluated
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2. Endometrium aspirations
3. Ultrasound
iv. Medical management
1. _________________
c. Cancer of the Ovary (pg. 1689)
i. Pathophysiology
1. About ________detected in the late stage – with metastasized
2. Age ________ - ___________
3. Risk factors: _________________ & ____________________
ii. Clinical Manifestations
1. ___________ abdominal girth
2. pelvic ___________
3. ______________
4. ______________
5. ________ waist size
6. _______________pain
iii. Assessment and diagnostic findings
1. NONE
iv. Medical management
VII.
Discuss the nursing interventions in pre and post-operative care of patients
undergoing hysterectomy (pg 1691)
a. Pathophysiology
i. Hysterectomy is the surgical removal of the ___________________
ii. Total Hysterectomy: removal of the ____________ & ___________
iii. Sub-total or supra-cervical hysterectomy: removal of the ____________
but not the _______________
iv. Radical hysterectomy: removal of the uterus & , __________ (upper 1/3)
pelvic ___________ nodes, _____________ tubes; and __________
1. Usually performed due to _______________ condition
b. Variety of approaches
i. ____________________
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ii. ____________________
iii. ____________________
c. Pre-op management
i. _______________?
ii. Empty ___________________
iii. Empty ___________________
iv. ________________________
d. Nursing Diagnosis/interventions
i. Anxiety related to the diagnosis of cancer, fear of pain, possible
perception of loss of femininity, and disfigurement
1. ___________________________
2. ___________________________
ii. Disturbed body image related to altered fertility and fear about sexuality
and relationships with partner and family
1. Discuss _____________________
2. Orgasm
iii. Acute pain related to surgery and other adjuvant therapy
1. Assess: ________________
2. Administer: __________________________
3. Teach alternatives
a. _________________ techniques
b. Early _________________
c. _____________________
e. Potential complications
i. Hemorrhage
1. Assess _________ pads
2. Assess _____________
3. Educate on ______________ restrictions
ii. Deep vein thrombosis
1. Prevention
a. Elastic compression _________________
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b. Early _________________
2. Assess for DVT’s
a. ______________ ( ______________; __________;
_____________; ____________)
3. Assess of PE
a. ________________ pain
b. __________ pulse
c. ___________________
iii. Bladder dysfunction / Urinary ______________
1. ______________
2. Assess bladder _______________________
3. Stim. bladder: _________________________________________
4. ____________
VIII.
Breast Cancer
a. Risk Factors
i. Gender ________________________
ii. Age: __________________________
iii. Personal History ____________________________________
iv. Hormonal factors
1. Early _____________________
2. _________parity
3. ____________ menopause
v. ____________________
vi. ____________________ use
vii. **No evidence that oral _____________________________increase risk!
b. Characteristics
i. Most common location: _________________________________
ii. __________-tender
iii. __________________, ____________________, Irregular boarders
c. Advanced signs
i. _______________dimpling
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ii. Nipple _____________________
iii. _____________________ ulceration
d. Types of surgeries
i. Modified Radical Mastectomy
1. Removal of
a. _____________________
b. Nipple –areola
c. __________________ lymph nodes
2. Not removed
a. Pectoralis major and pectoralis minor _________________
ii. Total mastectomy
1. Removal of
a. ___________________
b. Nipple-areola
2. Not removed
a. Axillary ___________________ nodes
b. _________________ groups
iii. Breast Conservation Treatment / AKA (_____________________)
1. _________________ or segmental mastectomy
2. Removal of _________________
3. May include axillary ___________________________
IX.
Discuss the nursing interventions in pre and post-operative care of patients
undergoing mastectomy: (pg. 1716-1725)
a. Postoperative nursing diagnosis and interventions
i. Pain
1. Assess
2. Administer
a. Analgesics
b. Oxycodone & acetominaphen (Percocet)
c. Propoxyphene & acetominaphen (Darvocet)
3. Non-pharmaceutical measures
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a. ___________________________________
b. Position __________________________
c. ____________________ techniques
4. Report
a. ____________________________________
ii. Impaired skin integrity
1. _________________ tubes in place
2. _____________of tubes
3. Hematoma’s
4. ___________ packs
iii. Risk for infection
1. Drainage tubes duration: ________________
2. Teach:
a. ____________, ______________, _____________
b. ______________ care
c. S&S of _______________
i. _____________ drainage
ii. _______________
d. No _____________ until completely healed
iv. Disturbed body image
1. Support
v. Impaired sensory perception related to sensations in arm, breast, or side
1. Tightness, pulling, burning, tingling in the chest wall, axilla, upper
arm
2. ____________ with healing  lasts ____________  diminishes
3. Teach “this is ______________”
4. exercise  _________ sensation
vi. Knowledge deficit: Prevent complications from surgery – lymphedema
1. Results when lymphatic ____________ are inadequate to return
flow of lymph fluid.
2. Transient _____________
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3. Medication: __________________________
4. ____________________
5. Manual lymph drainage:
a. Light____________________________,
b. performed by a _________________________
c. assists moving the _____________________ to other parts
of the body
6. Compression bandaging:
a. multi-layered _________________________after massage
b.
keep the fluid out of the arm
7. _______________________________
8. Do not perform ____________________ on affected arm
9. Do not take _________________________ on affected arm
10. Avoid ________________________ arm position
11. Compression garment:
a. _______________
b. helps maintain _______swelling achieved during treatment
X.
Study questions for Female GU
a. Describe anatomically the location of the vagina, uterus and ovaries
b. Describe the processes of ovulation
c. What hormones are involved with menstruation
d. What happens to the ovum after ovulation?
e. What happens to the ovum cyst after ovulation?
f. Where does fertilization take place?
g. What are the hormonal changes during the follicular phase of menstruation?
h. What physiological changes happen during the proliferative phase of
menstruation?
i. What are the hormonal changes during the ovulation phase of menstruation?
j. What physiological changes happen during the phase of menstruation?
k. What are the hormonal changes during the Luteal phase of menstruation?
l. What physiological changes happen during the luteal phase of menstruation?
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m. Define menopause.
n. What is the average age of menopause
o. Name 10 questions you would ask a women during a GU assessment?
p. What two exams should be done annually on a women?
q. What is a pap smear? What is it used to diagnose?
r. Bimanual palpation is palpation of what two things?
s. What is vaginitis?
t. What is the normal pH of the vagina? What maintains this pH?
u. Describe the common S&S of vaginitis.
v. What increases the risk of developing Candida?
w. What is the typical vaginal discharge like for a patient with candida?
x. How is Candida treated pharmacologically?
y. What increases the risk of developing Trichomonas?
z. What is the typical vaginal discharge like for a patient with Trichomonas?
aa. How is Trichomonas treated pharmacologically?
bb. Identify 8 nursing measures/interventions for a patient with vaginitis
cc. Define PID
dd. What are risk factors for PID
ee. Name 6 clinical manifestations of PID
ff. What is peritonitis
gg. Name 6 complications of PID
hh. What medications are used to treat PID?
ii. Name 6 nursing interventions for a patient with PID
jj. Define/describe endometriosis
kk. What are the clinical manifestations of endometriosis? (name 4)
ll. What is the medical management of a patient with endometriosis?
mm.
What are the risk factors for cervical cancer?
nn. What are the S&S for cervical cancer? Early and late stage
oo. What are the risk factors for uterine cancer?
pp. What are the S&S for uterine cancer?
qq. What are the risk factors for ovarian cancer?
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rr. What are the S&S for ovarian cancer? Early and late
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